To observe the effect of G-arm assisted plasma radiofrequency ablation combined with ozone in the treatment of inclusive lumbar disc herniation(LDH), and to analyze the relevant factors that affect the recurrence of LDH.

A total of 353 patients with inclusive LDH who were admitted to the Department of Third Orthopedics, Beijing Changping Hospital of Integrated Chinese and Western Medicine from May 2017 to July 2019 were divided into minimally invasive surgery treatment group (n=180) and conservative treatment group (n=173) according to the random number table method. The minimally invasive surgical treatment group was treated with plasma radiofrequency ablation assisted by G-arm combined with ozone therapy, the patients were treated once and hospitalized for 7 days as a course of treatment. The conservative treatment group used functional exercise, symptomatic analgesia and physical therapy, once a day, 7 days of hospitalization as a course of treatment. Before treatment, immediately after the course of treatment, 1, 3, 6, and 12 months after the course of treatment, the visual analogue scale (VAS) was used to observe the improvement of pain, the Oswestry dysfunction index (ODI) score was used to evaluate the effect, and the VAS and ODI scores of the two groups were compared. Logistic regression was used to analyze the factors affecting the recurrence of lumbar intervertebral LDH. Rank sum test or independent-sample t test was used for data between groups, and paired-sample t-test was used for data within groups.

Twenty-one cases were lost to follow-up, the rate of loss to follow-up was 5.9%, including 9 cases in the minimally invasive surgery group and 12 cases in the conservative treatment group. The minimally invasive surgical treatment group and conservative treatment group immediately after the end of the course of treatment compared with the VAS score before treatment, the differences were statistically significant (t=3.15, 2.73; P=0.013, 0.032). Before treatment, there was no significant difference in VAS score between the minimally invasive surgery treatment group and the conservative treatment group (t=0.66, P=0.596); Immediately after the treatment course, 1, 3, 6, and 12 months after the treatment course the VAS scores of the surgical treatment group were (3.22±0.76), (2.66±1.05), (2.07±1.14), (2.10±0.96), (2.32±1.15) points, respectively, compared with the conservative treatment group [(4.07±1.37), (3.76±1.14), (2.63±1.17), (2.63±1.41), (3.23±1.21) points], the differences were statistically significant (t=3.09, 2.75, 2.46, 2.11, 1.96; P=0.004, 0.029, 0.043, 0.045, 0.042). The minimally invasive surgical treatment group and conservative treatment group immediately after the end of the course of treatment compared with the pre-treatment ODI scores, the differences werer statistically significant (t= 2.75, 2.73; P=0.003, 0.011). Before treatment, there was no significant difference in ODI scores between the minimally invasive surgery treatment group and the conservative treatment group (Z=1.63, P=0.632). Immediately after the treatment, 1, 3, 6, 12 months after the treatment, the ODI scores of the surgical treatment group were (19.70±14.31), (22.31±12.60), (16.46±10.11), (13.17±10.45), (12.63±10.11) points, compared with the conservative treatment group [(20.43±13.14), (21.57±14.11), (18.72±13.17), (17.64±14.22), (13.09±10.22) points], the differences were statistically significant (Z=2.24, 1.95, 1.66, 1.78, 1.69; P= 0.013, 0.032, 0.036, 0.040, 0.044). Logistic regression analysis showed that the patients′ age, weight-bearing fatigue, living life, and minimally invasive surgery were independent factors influencing the recurrence of LDH, which were statistically significant (P=0.012, 0.011, 0.004, 0.001). Gender, concurrent underlying diseases (hypertension, diabetes, coronary heart disease, cerebrovascular disease), outpatient reexamination were not associated with recurrence, which were not statistically significant (P=0.232, 0.076, 0.054, 0.140, 0.251, 0.085).

Plasma radiofrequency ablation combined with ozone for treatment of inclusive LDH can achieve significant therapeutic effects, effectively alleviate the patient′s pain symptoms and improve the patient′s ODI score. The follow-up found to maintain regular life habits, avoid lumbar weight bearing, and early active minimally invasive surgical intervention can significantly reduce the recurrence of LDH.